HomeMy WebLinkAboutBuilding Permit 99-0384
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.~-~ CITY OF PRIOR LAKE (~f~
'~~: J.lepartmtnt of Jiuilbing 3Jn~ptction ~~I
l '~~ 'fiJ Final Permitted 0 Conditional C.O. Expires . "... ftJ
-1- This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Cod_.
~;~ certifying that at the time ofissJance this structure was in compliance with the various ordinances of the"
City of Prior Lake regulating ~ilding construction or use. For the following: '
Use Classificatioll
Siml1~lv
Q9;zH..1I.'
Rl
t
1
Bldg. Permit No,
Occupancy Type
R3
VN
B/A
Zoning District
Type Construction
Fire Zone
1
Legal Description
L3, B4, Knob Hill 2nd Addition
Owner of Building
Site Address
14426 Pike Lake Trail
i
t
I
Contractor's Name & Addres. M.lI Johnson. Constr. Inc., 17645 Juniper Path. Lakevllle
't-21.J-
Robert D. Hutchins k'71 rity Planner
Building Official I'
Date: 10 - ,d. 0 - 00 Date:
POST IN A CONSPICUOUS PLACE
Jenni Tovar
DATE TIME
~ 3 '00
J 44-2 fo . PI K 6 L-t:::- 17!?-
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDA~ION
o FRAMING.
3rINSULATI
0\. FINAL
I ] SITE INS C N
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
qtj-3B4-
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
~hY)d) ~ ~1~X''''~ ~
GJ g UA.-rJ '+v~.../ ~ CWJt,t'1\? ~
~ ~,,+. AR. :,nc:. '
(IJ ~~ IV'- ~o~<;o'r' ~~
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/7(j150
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E NEXT INSPECTION 24 HOURS IN ADVANCE.
lNSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS -I*~
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
=F ING
o ULA TION
FINAL
o SITE INSPECTION
COMMENTS:
-ituuG
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i/Lp, I A
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t:d!~V/ ~hlt
At.? 1'11' 17a//! C2.;'L
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/f;lt!- La Re h /;/1
CONTR. !tM:Y(?AAf~
PERMIT NO. 79-3'/~
~;RAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
SCHEDULED
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
/it' /'1t?/# s-/fhd' of
JJ /JIJI- t'?ct7l J/r-?i&/ c:l/~d
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~
/'
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W<>>>7AL~ F~~ECTIO~E COVERING
Inspector: #~ ~nf!!!rl\.,;ontr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTI
'T
7Z'1
ADDRESS
/i/ L/d fa
DATE TIME
SCHEDULED / b -)0 -00 14- r
p/k'F' La~ Jr
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
qr;-3~t./
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
o FINAL 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH F=~
COMMENTS: S H "
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
~9ASLlNE AIR TST
VwORK SATISFACTORY, PROCEED
o CORRECT ACTIO~A D PROCEED
o CORRECT WtK C . LL FOR REINSPECTION BEFORE COVERING
Inspector: I Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &; SAFETYI
INSNOTl
. ,,...
, "
DATE
TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
101l49J ~
I
ADDRESS /1/1/2.(, ~Ke: I A~!. M6il.-
OWNER CONTR. fI1. w. ~,J~tJ
PHONE NO.
PERMIT NO.
~~
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
K FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
)( EX/GRAD/FILLlNG
h'cOMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
~~ ON 7"'~
(!~ I)D~N
J-InM€.<
SI.l:::.E l..-o1" UtVE~ tJ'E'Eo "10 liF
'10 ACCol'1-,04TE- Ab:JACE-NT F\lTvllE.
5n:r.P ~t.oPE..5
~ '17;> a::
o~ ;-HE.
(W{~eC-r €A
gAd< O~ ,/a.lE r.tA1.4;E..
I!I1RKf?qc ^'t~5 "1""0 '8€. RA~elL-FLvS":f I. 11TH
-:Ii#' 9=i tV A L ~ AJ::JE..
~ B,N ,J~s "'0 aE ReP\oJp 1\
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
)( CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
I
Inspector: I1J.Jh ~ontr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTI
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
1-{3~cp,
!.130-
ADDRESS \442..t? A~ ~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
~~ - 35+
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
AD PLUMBING RI
~ECHANICAL
A TER HOOKUP
SEWER HOOKUP
1^ 0 SEPTIC INSTALL
1'"\ 0 PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLING
o LKSHORElWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
COM~ENTS:' ~ .." ,\ '.
2- ?, ~ ~ \In 40
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-- NO L~s
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0"'-
~~ 6.1< l~ C~
Me. A J/.-
-
~~
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/
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/
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URKSAlj
o CORRECT
o CORRECT
Inspector: Owner/Contr:
CAL~ 447-42JO FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
COD~REMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
.,.
~f/9~ .i!PJ
/4~ZfJ:; P/Kb L)C.. //<::.-
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION A- 0 MECH RI
o FRAMING f ~'" 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
o FINAL ~PLUMBING FINAL
o SITE INSPECTION ~ MECH FINAL
~~
CC?MMENTS:
f> IIa:1J
(0 f ~~
fk'
o
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toy
fLu
.E~
~
(
~ ~t/
AJ.l) f'- '~.
O' . ~
DATE TIME
r9~3e4-
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
h~U~
dO~
-..
/
~~SAT
~
.J
----------
RE COVERING
Inspector: wlltmvontr:
CALL 447_98~OR <THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIR ENl S ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
DATE RECEIVED
APR I 6 !999
P)H~
LOT
BLOCK
ADDITION
H I t-.1-
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
of./\
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
llan Check Fee ............................. $
/ State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechaoical Permit Fee ..................... $
Sewer & Water Permit ...................... $
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
tAt<&:
77ZA / '-
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
j 'To/-;J (P
,
3. LEGAL DESCRIPTION
J
KNob
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) ,,' (DePth)!)~ I
12. NO. OF STORIES Q (/1'lJV
13. TYPE OF CONSTRUCTION FI?Jv'fI--
AD h .AliJ'J - :5INr.J1 ~AJl/JLY J)JII!lJJ~>~
4. OWNER (Name) 1vb.V<. ':::>,~~ (Address) <SJ I ~ 10D (Tel. No,) ( (,Q) 14. FLOOR AREA APPORTIONMENT USE '
/'1b1JliJM:J)N ClJlli51 INr 17~'K..:l'UNJPJ.'l1. Plt11-J J./JmJ1lf JW~~ ~0Q r-r 1(4-0
5. ARCHITECT (Name) (Address) S tll-ni: II D (Tel. No.) ( ~ l..:2)r./ "H.i.J.J.y 8 (p J..j-
OIAPJJLS PfllilJJ?) OE5Jb;N 11~ ;:;rUJi/~ J>1t.1l1 71J1~U'tt U pPJ:YL, f{~l.f
6. BUILDER (Name) (Address) SUITi5 IOu (Tel. No.) rUd) 15. NUMBER OF OCCUPANTS OR SEATS
/7{/-f:)' V1JAJJ p~ PAlH l' OCCUPANTS S F D
In! .J1JJtjJSDN C/)iIi~ INr ~AKe: V/~ ~J --.9DO
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0 Re-roofing 0 Porch 0
New ConstructiO~ Alterations 0 Addition 0 Finish Attic 0 Re-siding 0 Finish Basement 0 16. PROJECT COSTN ALUE
Chimney 0 Misc. ;$ J /3 50 0
8. PROPERTY AREA OR ACRES 9, PROPERTY DIMENSIONS 10, CULVERT SIZE 17. COMPLETION DA4E
Sq.Ft. J~_ObJ S~U. Width /3'5 Depth gg,l'l Yes F) 7/q<J
I hereby certify that I have fumistkd information on this application which is to the best of my knowledge true and cemlCt. .1 also certify that I am the oimer or authorized agent for
the ab~.ve mentioned property and that all construction will co5rm to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
bUildin~.. official c~~ermit for just ca~se Fu more I hereby agree that th. e city official or a designee may enter upon the property to perform needed inspections.
X i ~/ , 000;);)07 o/P1 jq1
! ' '" signature /11 JOf/(liJ;(J1I Cotbr INC. License No. Date I
FOR ADMINISTRATIVE USE
'i-
~lJD
Permit No.
1. DATE
1/ Itf J qq
I I
PID 25 -33q- 0'2-1- 0
Back
Side
SEATS
L White
2. Pink
3. Yellow
File
City
Applicant
qq - 3B4-
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMITVALUATION-1W;O~. c90
S U
City:
Water Tower Fee ........................... $
Water Tap ........................ ...... ..... $
Builder's Deposit ............................ $ /. t:;(J() . 1ge)
I
Other ......................................... $ - -, . 7
Total Due .............................. $.J.3Cj'f , ~I"
Paid 739 ~ c/7 Receipt No.3SS IS-
Date f4 /1 ~ / t!j'tt:} By
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning' Ordina,(ce and may proceed requested. This document when
sig~ ~ City ~er constRutes a temporary Certi~e~f Zoni~ compliance and allows constru~' n to ~encx ~fore oc<Jlparcy, a Certificate of Occupancy must be issued.
~ ~ . k-""1C'( <:.,.", .,- (~j\-~'
'./ City lanner Date - - Special Conditions ff any
24 hour notice for all inspections 447-4230
erA t"J . 2~
G-ti I . 1?--
(00.(0
Loa. ~v
W ~ ("sO
~S"' .50
^ ~ ~ (Nt\.
~\0'
\o'~
Gas Fireplace Permit f.................... $
~~iS ft'fJI:. B~es Your Building ~:tr;:ithr~ ~rred.
cert::::::2'pancy
Issued
PLANS & SPECS 0
SURVEY 0
PLOT PLAN 0
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... ll".
Pressure Reducer ..%~I.................. ~.
Meter Hom ...~.p........................ ~
Water Meter... ~........................... $
Sewer & Water Connection Fee ........... $
'."T'.
SETS
COPIES
8ED. c?c>
t{j5rJ .~
I
~6.&:J
L ~6'". CO-
I, ?-I'lO .rJ(1
t-z (J () .cr')
ADDRESS
OCCUPANT
HEAT LOSS
SOLD BY
Electrical Work By
TYPE OF HEA T
HOUSE HEATING TEST RECORD
II/t/~ &~ L:.lCe r
APT.
OWNER
FLOOR
If/; 0 r fA /( '€..,
CITY SUBURB
DA TE HTG. INST.
GA
. I
FAX, HW
STEAM
INSTALLED BY CONTROLLED AIR
Ga. Line By CONTROLLED AIR
SPACE HTR. UNIT HTR.
OTHER
..-.-- . 1_ D GAS DESIGN
MAKE --/ ~1.. v~
Mod.1 TUO 1);;0 cg,tP 16
S...ig I
INPUT
CONVERSION
w!C
?f. ..CONTROLS
THERMOSTAT" +,sr.vt;L Heat PI~
Valve
Limit
Limit Setting
Fan Setting
Pilot Type
Pilot Make
Pilot Model
Pilot Timing
L.W. Cut Off
L // (,./c:... '
Pressure <) I... ...,. Percent CO ~. 4
. 2 r
. " , Percent O2 ' ....
~ h r 'f" Percent CO 0
,R
.MAKE OF BURNER
Model
Mox. BTU Rating
MAKE OF FURNACE
Model
Vent Sin r;- ~
KIND OF LINER__/JJ.re-'lr SIZF
Draft Hood '.., Regulalor
Fi Ite,. Size /6 rI .-'/6 Number
O\imney Location In.ide Our-ide
o,imney Construction -h- ".4
- , I
NONF
/qo VI':'-
.'7 f ;.-"... .. 111
Smoke Bomb
Draft
Door Pressure
Input CFH
Stock Temp.
Form 235
Date T e.ted
Company Tuting
Name of Te.ter
/D-I J -9'1
CONTROLLED' AIR
fill~
..
Wiring
Te.t Tag
Lighting In.t.
---......
dd Itl/./ J /. ,q Go t~ ~ It
Job A ress 7' 7 pUr! .
Controlled Air
Heating Contractor (f[ 11- '
Name of Tester '. ~.
/-(fi - /7 y.rr
7~ 5-
?... ((
t~ -
36g'lr
Date
Percent 02
Percent C02
Percent CO
Stack Temp.
q9- 384-.
Thr Ctnlrr of tht Lakt Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
M.vv. JOHNSON
4-/ { Co I qq
, I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
I 4-4- 20
Pf r'<E LA I~E- (kA { L-
Accepted
Accepted With Corrections ~
Denied __ p ____
Reviewed ByL~r
Comments:
J. ~ ~ a~c4&
. Date:
G-(~- cr9
~cn A i,,-, .
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
!.
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~~ '~.,., :;k.;'. ,.~".'.'
t.. . )~ '-;;"")' /
. r/- ...J) ~
.
White - Building
Canary - Engineering
Pink - Planning
Thf Crnlrr of the L.kr Country
aUILDING PeRMIT APPLICATION DEPARTMENT CHECKLIST
I
NAME OF APPLICANT ~ I. \ V. JCif-\ 1', ~,O /~
APPLICATION RECEIVED. 4-/ I & /i (")(7
~/)
The Buildi~~ Er@'"~ering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
i 4-4 20
P 11-< E
LI\ I<c...- '-rkf\ l L-
'.1"
Accepted
./
Accepted With Corrections
Denied
I' Reviewed By: JJr41.. TF-ta. ErfA-~5Mt4tVN
Lflrtj,P1. IS' ()~/
Comments: .'k'u,JoFI=" Mv.:sr BE C<::".)u~~c.J:j
Date: .lIlP/f9
. -.
/0 ,q"",o t-h.VN(,., Da,q.,N4l,E
,
~ t\1\l..In' E",sE\l\1.~,vn. A.J t1-f.vc..ri ~!J.
PttIlCrrCIlf.... "
I SPoKE, Wl-rH
_=:ro~.v LAa.s.ot...l oF' ~oI'JEE'1l.. f"u,'I<JErlllloJl:I AAJC
/-'It: IS Glo,.....t. 10
. \)PbATE
'-,-u: .Sou ~ - ChJ IS 'ON
BRAO. ^-.Ju RAN
Bt t'H(.INl",.)u 1iIE. SlylL
OF Ho\,JS€ f"ito,,", RM13LF:1l. r<:> LOOK our.
'It'it:. CHAAlt.E ot: UDIJS.E.
.S.,......L.E
1...J''-L. !'lor
,qCU~$'-'l" AJ:j:'EC.T DtlAI...JA-C;t ON lIotlS
~If...
. A~c.E..n- LoT5.. :5EE IA1f"oR.MAT' ON ON RE 1If:1t~E. .sr~E.
.",~ A,.nH.Ht"IE.aJrs: I. r=;~(),1... {J,/Mac I.AJSPeC7-'Ot\J I.oFlJlf.tftllnON 2 &R4(iIN6 Pc..t411J
:3. [~6S'C.u C.Oi>JTlI..lJL ~EJI"'rJ((E:5;.
l/-. ER.a.<.1 (JAJ C t!J A.Jfl( ilL +l.IlAJ
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
tf
~
1II,'l,li' I~__"....,,...~, J'l"'r-~'~~'''''~
. ,........ J~n .~..~
....
1 ." '''',....~,~..':'',.~''''t:~"....,;::?*f<,'\...,~...;!'Ift'~:'''l';;.~"O;:r{~~'J
/";\/"''-'' ") t /!
, , - /-
I~_...;}-r""-
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Tho Conlor of tho Llkr Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
, ,
1\ I
--
\' \ {/ Ii,
, ", -"-1.'
'.. "'-".! !
I
. I
r',J
!
/
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I /:.. /
i
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
L-- .i.r' .> I/?
I Ji_~~...
Ii/' ,-
" 1--
! ,~ \.........
\ V: F.,-r-k~ f\ \ L-
Accepted
v
Accepted With Corrections
Denied
Reviewed By: ~.A<UJ~ ~
Date:
0-{w~f10
Comments:
~~ jh/~I.A_~~ L-tq~7~ ~. ('~-Art:J
/5 :2-'-1 ~". ~ (EY;. ~ /?<- ,{~W fvq:w"S VVIe-,.
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
The eenler of the Like Country
Applicant: ,4;:J~~:;RMIT
Address: J ~;J::i!iJ/~w ().j K:t>jor r;. -
Signature: ... st::::f
Legal Description: Lot 3 Block 4- Sub KtVIJtJ /fla ZN.O
Site Address: II.jJl/-fo. F>t~ lab: ./-rat' I t<. /
Building Permit # q t9 - 38'1 PID # 2.5 -. ~~1- 0 z. 1-0
NOTE: This permit will not be processed without complete information.
PPNo.
Phone: t/;1....... iJ)~-lq 3 <....
. .-
1. Blue File
2, Gold City
3. Yellow Applicant
qt; -38/
CITY OF PRIOR LAKE
FIXTURE UNITS
Quantity
Type of Fixture
Quantity
Type of Fixture
:;<
I
I
3
I
Bath Tub with or without shower
Dishwasher
/
I
Rough-ins
Water Heater
Floor Drain
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
I
Water Softner
Stand Pipe (washing machine)
Sewage Ejector
Backflow Assembly (RPZ, Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other
I
Sinks
:3
Bar Sink
Water Closet (toilet)
FEE SCHEDULE
Industrial, Commercial & Multi-Family
(1 % of job cost, $39.50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
$99.50
$39.50
$
$
$
$
.50 I
o 8
$ -i2ft I
~.C/
GRAND TOTAL
This permit is granted upon the express condition that said
contractor, shall comply in all respects with the ordinances
of the State Plumb' od an amen9mel)ls thereof.
. t8/q /9CJ DATE
, ,
ATIEST
Call for inspections 24 hours in advance.
16200 Eagle Creek Av. S.E. Prior Lake, MN 55372 / Ph (612) 447-9850/ FAX (612) 447-4245
An Equal Opportunity Employer
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. '8200 ilgle Creek Av_ S.E, Permil No. qq .._.384-
Prior Lake, MN 55372 4'.
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. _ HEATING APPLICATION I PERMIT
Date. tzllffre'( Pto, ZS-339- 02-11- 0
Sa. Add;..- . \44~ Pt (,('e La.k~ J. e J
lot .3, Black 4- Addftion !eN 0.8 HI (; '- 2. N.{:)
Owner'IName RI1\. Ye.\JltH VA.SS.\Ll ~ "'t:;~
Addr.. l44).(p f1~ We. ~,,~ q/ / '~
Heating Contractor ~~",./J aU) J1~1 / /" ".~
Add~SlI .;tl~tQ <aahw ~ '/ ~.I ~
Telephone' ~ 51 4~o ~OO '). f \ '.
FwnBCI Make & Model T~ TYPE OF SYSTII:U ~ .
l1J 0 00 O'2f Warm Air Plants::5<\.
Model Sill cJ Del ~ _ Gravity '-
Conn.load '5Gef:> &,. MechanIcal ~
,j Atr Conditioning
Fuel N at- Flue Size Vent System
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Suppty Openings 11 HEAliNG OR POWER PLANT
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Return ~enl~s ~~ Hot Wa1er
oVO> . {) d V LJl Radiation
Inplll 80, OUtput "4; ~ Special Devices
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nPEQFWORK n7;v
Alterations , Replacemem. New Construction ~ J' f!
Repair , Est. Comp. Date c:~r (d
ButldingPermitll . 99-381 ~~
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'l BUILDING
Receipt tI
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Est. Cost $
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HEATING PERMrT FEE $
STATE SURCHARGE .
.50
TOTAL PERMIT FEES $
TYPE OF STRUCTURE
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File
City
CllMrlClior
SIngl8 Family
CClmmerotal.
)(
Multi-FemRy
Public Other
Two-Family
Ind\l81rial
Fee Schedule
::dUSlffal. Commercial & Mum-Familv i.
Resl ~ial. Hea1ing & AC H4;. t A,
Reside af, Heating Only
Reslden1 ai, Gas Fireplace
ResldenYal, Additions & Aller&1ions
Reslde,,{lal. AC Only
~,.,~ Dat ($39.50 minimum)
nt' r'''
$64.60
$39.50
$39.50
$39.50
Reof'ember to add the Stale Surcharge on lhe bottom of this applicallon.
...
The price o' your healing pel mil includes one rough-in and ooelinat inspection.
Additional inspections w~1 be billed at $35.00 each.
HOllSe Heating Tesl Reoord must be submitted with ~pllrfl"" ~rmlt ""~tl'\r berore build-
ing certificate of ocoopancy wilt be issued.
t-(i= AT CALCULATIONS RFOlllRfn wilh number 01 supply and rehlf'n openings lis1ed per
room wilh CFM'. per opening. New s1I\lc!urea Ot additions send floor plan wilh supply
and return IooaUons ~hown. HEAT lOSS CALCULATIONS, PAVMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 18200 EAGLE
CREEK AVE. S.E. PRIOR lAKE, MN 55312.
City Hall business hOUfS are B a.m. -.4:30 p.m.
ALL WORK MUST BE 'NSPECTED (FlOUGH-IN AND FINAL) . CALL CITY HALL
447-4UO
I hereb apply fot 8 mechanical eVltems permil and I ac-knowledge that the
inlor 'on above is complete !Ind accurate; thal1he work will be ill conformance
w' the ordinances and codes o' the city and with the Btale building/mechanical
codes; Utat thi.s form does not become a permit unlll signed by Ihe BUILDING
OfFICIAL; that the work will be in accordance with the approved plan In the
case 01 Jlft..workAvhich requJrel review and approval of prans.
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PR,IOR LAKE
INSPECTION RECORD
SITE ADDRESS I LJLj~~ \;?- k.l2.lo("-P ll--'
NATURE OF WORK ~'\ C"d;lA~
USE OF BUILDING SF.D
PERMIT NO. CJ9- VS)t( DATE ISSUED
CONTRACTOR . ~ lA) t \~~\A~dJ~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
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INSPECTOR / DAT.E
, FOOTING 4<. IJ I &, /~-9 /97
I FOUNDATION (Prior to Backfill) I . (1[) I 7, '1- t19
PLACE NO CONCRETE UNTIL ABOVE HtJ BEEN SIGNED
R/10 UGH - INS
SEWER I WATER I SEPTIC (P 7)8)11 ~.
FRAMING I ,IV)
INSULATION ~ f1 (
ELECTRICAL I \ I
PLUMBING rtv' ~
HEATING (if required) h/ ~
FIREPLACE
GAS LINE AIR TEST ~ oAv ~ X/I/O -4'1
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
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FINALS
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lY/fr-17
f.. tJiJ -'19
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GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy
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(7 .J 5 1\ :5l q~
UNTIL ABOVE HAS BEEN SIGNED
NOTICE
This card must be posted near an electrical service cabinet prior to rough-in inspections
and maintained until all inspections have been approved. On buildings and additions
where no service cabinet is available, card shall be placed near main entrance.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
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